What You Need to Know About Skin Cancer

Think having that mole checked can wait? You could be dead wrong. Here, what you need to know about malignant melanoma. It could save your life.

By Christie Aschwanden

(Photo: iStockphoto.com)

Interferon’s side effects range from exhaustion and flu-like symptoms to depression. For Jenkins, the fatigue was overwhelming: "Walking up the stairs or putting detergent powder in the dishwasher would take all my energy." And once her treatment was over, she found herself obsessing over the future, fixating on her doctor’s suggestion that she could be dead in three to five years. "I made it through that third year and thought I had two more to go," she says. "I felt doom every morning when I woke up. I thought, ‘Today’s the day.’" When she reached the five-year mark, her boyfriend took her on a vacation to celebrate. Now that she has almost reached the eight-year mark, is she cured? Not necessarily. Melanoma is notorious for paying its victims a second visit, so Jenkins’ happiness is tempered with fear. "It can return, at any time and in any place," says Michael Gold, MD, a dermatologist in Nashville and Skin Cancer Foundation spokesperson. "There’s almost nowhere in the body I haven’t seen it come back to.""About five months ago I was really dizzy," says Jenkins. She feared the worst and immediately made an appointment with her doctor. "As they performed a CAT scan, all I thought was ‘Oh, my God, it’s in my brain!’ Luckily, it was an inner-ear problem." She still meticulously checks her skin for bumps and moles every day in the shower, fearful that she’ll find something. The superficial checking is smart, to a point: While melanoma can recur on the skin, typically, when it returns, it’s in the lungs, liver, bones, or brain. "Once you’re diagnosed [with a deep melanoma], you’re basically a patient for life," says Culbertson. "There are regular blood tests, plus they scan you everywhere, CAT scans, PET scans, MRIs." No Spot to SpotMelanoma doesn’t always announce itself with an obviously bad mole. When Lana Ricketts went to her gynecologist in October 1997 with an egg-sized lump under her armpit, she feared it was breast cancer. Her doctor said it was probably just a fatty deposit that she could have removed. It was a busy time: Her daughter had just started college in another city and Ricketts had planned a trip to visit, so she scheduled the surgery for three weeks later. Ricketts’ lump turned out to be a stage III melanoma that had spread to her lymph nodes. Ricketts, who was 45 at the time, was shocked by her prognosis: "I had a 33 percent chance of living five years."It is not uncommon that the original lesion is never found. In Ricketts’ case, it is possible that a "benign" mole she had removed years before contained a few melanoma cells which were missed in the biopsy, says Culbertson. Surgery removed all apparent signs of Ricketts’ melanoma, and to cut the risk that the cancer would recur, her doctors recommended injections of interferon alpha. But the drug’s rather slim effectiveness rate and the side effects dismayed her nearly as much as the disease itself. Instead, she enrolled in a melanoma vaccine trial at the National Institutes of Health. With support from her husband, her daughter, and a fellow melanoma patient, she made 18 trips from Illinois to Maryland for shots and follow-up visits. It was a gamble that may have worked; seven years after she felt the lump under her arm, Ricketts’ melanoma has not returned. But not everyone in her vaccine trial was as lucky. Of the 38 original participants, 34 have died, so it’s unclear whether it’s the surgery, the vaccine trial, or pure chance that accounts for Ricketts’ survival. New Moles Even if you’ve never had a skin scare, you can never be too vigilant about alerting your doctor to any changes in your skin, no matter how neurotic it makes you feel to report what may seem like a small matter. Three years ago, Patty Suessen did just that. Then 42, Suessen had gone to the dermatologist because she’d suddenly noticed a new mole on her right shoulder. While the mole didn’t fit most of the signs she’d heard about, it had appeared out of nowhere, so she decided to have it checked out. Suessen’s instinct was right. Tests revealed that she had stage II melanoma — the lesion was thickened and the cancer had spread to the lymph glands.